A quiet change in everyday foods could save thousands of lives

• In France, researchers found that cutting salt in baguettes and other widely eaten breads could lower daily sodium intake by about 0.35 grams per person. Over time, this small shift could help prevent more than 1,000 deaths nationwide, highlighting how modest changes in staple foods can have powerful health effects.
• In the United Kingdom, a separate analysis estimated that meeting the country's 2024 sodium reduction goals could reduce average daily salt intake by 17.5%. That drop in sodium could help prevent roughly 100,000 cases of ischemic heart disease and about 25,000 ischemic strokes over a 20 year period by lowering blood pressure across the population.
• Together, the studies underscore the impact of coordinated action among governments, food manufacturers, and public health leaders. Strengthening and enforcing sodium reduction efforts worldwide could deliver lasting improvements in heart health, researchers said.

Small Food Changes With Large Public Health Impact

Eating too much sodium is a leading contributor to hypertension, also known as high blood pressure. According to the American Heart Association, high blood pressure raises the risk of serious conditions including heart attack, stroke, chronic kidney disease, dementia, and other cardiovascular diseases.

Because excessive sodium consumption is a widespread public health issue, many countries have adopted salt reduction policies. Sodium, which is found in salt, is commonly consumed through everyday foods. Reducing salt intake at a population level is seen as a way to improve long-term health outcomes while lowering health care costs.

The new research includes two modeling studies. One was conducted in France and focused on planned sodium reductions in baguettes and other bread products by 2025. The second examined sodium reduction goals set for 2024 in the United Kingdom, targeting packaged foods and takeaway meals.

Both studies estimated what could happen if these sodium targets were fully met. The projections suggest that small reductions in sodium levels across commonly eaten foods could produce meaningful public health benefits. Importantly, these changes would not require people to alter their eating habits.

"This approach is particularly powerful because it does not rely on individual behavior change, which is often difficult to achieve and sustain. Instead, it creates a healthier food environment by default," said Clémence Grave, M.D., lead author of the French study and an epidemiologist and public health physician at the French National Public Health Agency in Saint-Maurice near Paris.

The World Health Organization advises adults to consume less than 2,000 milligrams (mg) of sodium per day, although average intake worldwide remains much higher. The American Heart Association recommends a maximum of 2,300 milligrams (mg) per day, which is about 1 teaspoon of table salt. It also notes that an ideal intake is no more than 1,500 mg per day for most adults, particularly those with high blood pressure.

Sodium Reduction in Bread (France)

In 2019, France established a national goal to reduce salt consumption by 30%. This effort led to a voluntary agreement in 2022 between the government and bread producers to lower salt levels in bread by 2025. Bread, especially the baguette, is a staple in French diets but also a major source of salt, traditionally accounting for about 25% of the recommended daily intake. By 2023, most bread produced in France already met the new sodium standards.

To assess the potential health effects of this agreement, researchers used national data and a mathematical model. They estimated how many cases of cardio-cerebrovascular disease (conditions and diseases that affect both the heart and the brain's blood vessels), kidney disease, and dementia could be avoided if the sodium targets were fully achieved.

The analysis showed that if bread consumption remained unchanged and sodium targets were met, daily salt intake would drop by 0.35 g per person. This reduction would lead to modest but meaningful decreases in blood pressure across the population.

Estimated Health Benefits in France

Under a scenario of full compliance, the researchers estimated that:

• Annual deaths would decline by 0.18% (by 1,186).
• Hospitalizations for ischemic heart disease would decrease by 1.04%.
• Hospitalizations for hemorrhagic stroke and ischemic stroke would fall by 1.05% and 0.88% respectively.
• Men would see the largest overall benefits, with 0.87% of heart disease and stroke cases prevented compared with 0.63% among women. Among women, the greatest avoidable proportion occurred in those ages 55 to 64 years old.

"This salt-reduction measure went completely unnoticed by the French population -- no one realized that bread contained less salt," Grave said. "Our findings show that reformulating food products, even with small, invisible changes, can have a significant impact on public health."

"These results highlight the need for collaboration between policymakers, industry and health care professionals," she added. "By combining individual counseling with population-level strategies, we can achieve greater reductions in cardiovascular risk and improve long-term health."

The researchers noted that their findings depend on modeling assumptions and available data. "It is impossible to directly measure the isolated impact of reducing salt in bread because this change over time occurs alongside other factors, such as behavioral modifications or variations in bread consumption, which cannot be fully estimated here," Grave explained.

The analysis also examined outcomes for a single year. Longer-term projections would require additional assumptions and data sources.

Sodium Reduction in Packaged Foods and Take-out Meals (United Kingdom)

For the U.K. study, researchers analyzed national survey data to estimate how much salt people consume from packaged foods and takeaway meals. They then calculated how sodium intake would change if all relevant food categories met the country's 2024 sodium reduction targets.

Sales-weighted average and maximum salt limits were established for 84 grocery food categories, including bread, cheeses, meats, and snacks. For the first time, the targets also included 24 out-of-home food categories such as burgers, curries, and pizza. The modeling evaluated potential effects on heart disease, stroke, quality of life, and health care costs.

If the targets were fully met, average daily salt intake would have fallen from about 6.1 g to 4.9 g. This represents an estimated 17.5% reduction per person. Men were projected to experience slightly larger decreases than women because they generally consume more salt.

Even these modest daily reductions were expected to slightly lower blood pressure across the population, with benefits accumulating over time.

Long-Term Health and Cost Benefits in the U.K.

Over a 20-year period, the model estimated that approximately 103,000 cases of ischemic heart disease and about 25,000 strokes could be prevented in the U.K.

Across lifetimes, the associated reductions in blood pressure were projected to generate roughly 243,000 additional quality-adjusted life years (a standard measure of health benefit) and save £1 billion (about $1.3 billion in U.S. dollars) for the National Health Service.

The findings aligned with expectations, researchers said. "We know that cardiovascular disease is a leading cause of death in the U.K. -- as it is worldwide -- so any reductions in salt intake and blood pressure could lead to big benefits," said Lauren Bandy, D.Phil., lead author of the U.K. study and a researcher in food and population health at the University of Oxford in Oxford, England. "We also know that the food industry still has a lot of progress to make when it comes to salt reduction, so there's a lot of room for improvement."

"If U.K. food companies had fully met the 2024 salt reduction targets, the resulting drop in salt intake across the population could have prevented tens of thousands of heart attacks and strokes, saved substantially in health costs and significantly improved public health," she said, "all without requiring people to change their eating habits. Strengthening and enforcing salt reduction policies both in the U.K. and globally could unlock these benefits."

The researchers noted that some data on salt levels in foods may not fully reflect changes made closer to 2024. In addition, the dietary survey data relied on self-reported intake, which can underestimate sodium consumption, particularly from restaurant and takeaway foods.

Relevance for the United States and Beyond

Daniel W. Jones, M.D., FAHA, chair of the 2025 American Heart Association/American College of Cardiology High Blood Pressure Guideline and dean and professor emeritus at the University of Mississippi School of Medicine in Jackson, Mississippi, said the findings have broad relevance.

"Both of these modelling studies demonstrate the potential benefit in reducing risk for heart disease and stroke by reducing sodium consumption," he said. "This 'national' approach to limiting salt content in commercially prepared foods is a key strategy for countries where a major part of food consumption is from foods prepared outside the home. Though sodium reduction makes small improvements in blood pressure at the individual level, these small changes in individuals result in major improvements in a large population."

Study Details: France

Average daily salt intake in France was 8.1 g per day in 2015, with more than 90% of adults exceeding recommended levels. Traditional French bread and baguettes contained about 1.7 g of salt per 100 g, contributing roughly 2 g per person per day, or about 25% of total intake.

France set a goal to reduce salt intake by 30% and reached a voluntary agreement with the bakery sector in March 2022 to progressively reduce salt levels in all breads by 2025.

Researchers modeled expected reductions in systolic blood pressure and related health outcomes under a scenario of full compliance with sodium targets. The analysis accounted for different blood pressure responses among people with and without hypertension.

The model used systolic blood pressure data for adults ages 35 and older and salt intake data from a 2014-2016 national survey. Salt intake was estimated based on three 24-hour dietary recalls and combined with 2022 data from the national claims database, which includes information on hospitalizations, outpatient care, and mortality within France's health care system.

Study Details: United Kingdom

The U.K. modeling focused on the adult population and examined the impact of sodium reduction on ischemic heart disease, stroke, quality-adjusted life years, and health care costs.

Researchers used daily salt intake data from the National Diet and Nutrition Survey conducted in 2018-2019 to estimate changes if sodium targets were met in 2024. The survey collects food intake data from a representative sample of about 1,000 people using three- to four-day food diaries.

The study sample included 586 adults ages 18 and older, weighted to reflect the U.K. population based on 2017 estimates. Participants reported consuming 2,549 unique foods, with 1,532 of those matched to sodium reduction target categories.